Saturday, December 27, 2014

MY PERSONAL EXPERIENCE

I started from Pune at before 4am and reached a little after 6.30am at the building for vaccination. Everyday there are only 100 visitors who get vaccinated and I was number 104 in the list (where you put in your name and passport number). I decided to take a chance and wait. By eight there were 132 names. Initially we were all in an old room of Nav bhavan on the ground floor, but around 9.30 am they asked us to move out and line up. The line was made on the basis of the list and one of the visitors actually volunteered to help in this. I was well within 100 at this time, as about 12 people were gone already.

Waiting inside early in the morning...

The crowd waiting before forming a line...

Some notices on wall - none are followed

They take two batches of 50 each (or so I think) and so you basically have to wait for a long time to even know if you will get a chance. I was in the line from 9.30 to 12.30 and only then go to know that I won’t get my turn today. It seems many who were not in the line originally, managed to sneak in. Unfortunately no one was in the line after no 85 could vaccinated – despite standing in alternative sun and intense rains!

After trying unsuccessfully at the Seaman Hospital, I decided to book a confirmed ticket to my destination and try again the next morning at Airport Health Organization building. I was super frustratedafter my first attempt and so went to the best five star hotel around, sat in AC, ordered black coffee and chilled for a while! I also came to the Airport building once to check the timings and locate the place so that I do not struggle in the morning and waste some precious minutes. The guard told me to come around 8am.

However, after my experience at the Nav Bhavan Building, I came here at 6am and entered my name in the list right away – I was number seven there :) You can sit at the canteen and sip tea till 8.30am when they open the seating area and you can wait there till 10.00am when the vaccination actually starts.There is a TV, air conditioning and food - what more can one ask? The vaccination process takes almost no time, and its super well organized. You go in batches of ten and the doctor takes less than ten seconds to vaccinate, and before you even know you are out in the open and happy with the day :)

Friday, December 26, 2014

Bengaluru: It's time to explore the unexplored and for a healthy, happy journey. As Bengalureans head in droves to destinations literally in the wild this holiday season, they are also making sure it's a safe trip. So a visit to a doctor and then to the pharmacist to keep a medical kit ready is now a must.

The concern is understandable. Hot on tourists' itinerary this season are back-of-the-beyond destinations like Kamchatka in far-east Russia; Svalbard off Norway; Pantanal in Brazil; Masai Mara in Kenya and Tanzania.

Accessing these destinations is in itself a challenge for Bengalureans who live in year-round air-conditioned comfort. Kamchatka calls for a 75-minute chopper ride from Petropavlovsk and Svalbard, a 10-day sail. But the brown bears of Kamchatka, polar bears of Svalbard and wetlands of Brazil, not to speak of African safaris are worth all the trouble if travellers carry medicines and get vaccinated too.

Manipal Hospitals says they get at least seven patients a week seeking travel advice. "These hitherto unexplored, off-beat nature and wildlife destinations are now being preferred by Bengalureans. They need to be on their guard against sea-sickness, diarrhoea and fever," says Dr Mabel Vasnaik, head of emergency at the hospital.

Tour operators too give similar advice. "We tell all travellers to carry medicines as often these places are cut-off from cities and people tend to develop certain illnesses," said Giri Cavale, who conducts photography tours across the globe.

The first travel medicine consultation happens two weeks before the trip. During this, doctors understand the medical history of the individual, the places they intend to travel and nature of travel. "We ask them to come again four weeks after they return," says Dr Swati Rajagopal, consultant, Infectious Diseases and Travel Medicine, Columbia Asia Referral Hospital, Yeshwantpur. She gets 5-6 people daily seeking travel advice. A list of clinics in those destinations is also given.

BOXES

LOCALES AND ADVISORIES

Kamchatka

Complete with glaciers, rivers, springs and lakes, Kamchatka has 28 active volcanoes and an exotic wildlife. Tourists must watch out for infections and diarrhoea among other things.

Svalbard

80 degrees north in the icy Arctic is Svalbard. It is the northernmost part of Norway. Freezing temperatures can leave tourists febrile.

Sunday, December 7, 2014

Travel Restrictions Slow, but Do Not Stop, Pandemic

Sealing international borders, a tactic debated as a way to slow the spread of other contagious diseases, delayed the spread and peak of influenza pandemics from a few days to 4 months but, ultimately, on its own, it could not prevent dissemination of influenza, according to a systematic review.

Dr. Ana L.P. Mateus, from the Field Epidemiology Training Programme, Public Health England (East Midlands Office), Nottingham, United Kingdom, and colleagues report the findings of their metaanalysis online September 29 in theBulletin of the World Health Organization.

According to the authors, the World Health Organization (WHO) in 2007 included travel restrictions in an interim protocol aimed at rapidly stemming the initial emergence of pandemic influenza. Once a pandemic is established, however, WHO takes a dim view of such travel restrictions because of their effect on global travel and trade. Nonetheless, the strategy gained favor in 2009 as countries attempted to avert the arrival of A(H1N1) influenza virus.

In their review of 23 studies, the authors found initially positive outcomes with "extensive travel restrictions" that limited more than 90% of movement, but those beneficial effects were erased when the transmissibility of the viral strain increased. Internal travel bans could delay pandemic spread by roughly 1 week, but international travel restrictions reduced pandemic attack rates by less than 0.02%. Banning air travel by children may be effective but, the authors argue, is "socially impractical."

At the local level, travel restrictions "appeared to have limited effectiveness in the containment of influenza," the authors write. In Mongolia, for instance, a simulation restricting road and rail travel by 95% resulted in a 0.1% reduction in the pandemic attack rate. Likewise, in the United States, travel restrictions that were 99% effective in barring entry of infected travelers resulted in a delay of pandemic spread by just 2 to 3 weeks.

In densely populated England, Scotland, and Wales, a combination of internal and international travel could help to stagger the effect of the pandemic across the United Kingdom, the authors write, but at the international level, travel restrictions had "limited effectiveness," with a 40% restriction of air travel delaying by less than 3 days the march of A(H1N1) from Mexico to other countries.

A pandemic that began in Sydney, Australia, or Hong Kong would take 2 to 3 weeks longer to arrive in the United States if 95% of air travel were restricted. Selectively canceling one quarter of flights connecting between 500 of the globe's major cities, however, would pack more bang for the preventive buck, with an additional 19% reduction in infected travelers.

Travel restrictions that exceeded 90% could delay the spread of pandemics by up to 4 months for low to moderately transmissible strains, but with highly transmissible strains, such travel bans "appeared ineffective."

"The results of our systematic review indicate that overall travel restrictions have only limited effectiveness in the prevention of influenza spread, particularly in those high transmissibility scenarios," the authors write. "Only extensive travel restrictions — i.e. over 90% — had any meaningful effect on reducing the magnitude of epidemics. In isolation, travel restrictions might delay the spread and peak of pandemics by a few weeks or months but we found no evidence that they would contain influenza within a defined geographical area."

The authors reviewed evidence from modeling studies published before May 2014 and excluded studies that only examined disease spread among animals. The researchers included 23 studies, 19 of which were mathematical modeling studies.

"It seems likely that, for delaying the spread and reducing the magnitude of an epidemic in a given geographical area, a combination of interventions would be more effective than isolated interventions," the author conclude. "Travel restrictions per se would not be sufficient to achieve containment in a given geographical area, and their contribution to any policy of rapid containment is likely to be limited."

The University of Nottingham Health Protection and Influenza Research Group, which employs three of the study authors, disclosed receiving research funds from GlaxoSmithKline and unrestricted educational grants for influenza research from F Hoffmann-La Roche and Astra Zeneca. Among those three authors, one author further disclosed receiving funding before October 2010 to attend influenza-related meetings, give lectures, and received research funding from several manufacturers of antiviral drugs and influenza vaccines. This same author disclosed being an employee of SmithKline Beecham, Roche Products, and Aventis-Pasteur MSD before 2005. The remaining authors have disclosed no relevant financial relationships.

Bull World Health Organ. Published online September 29, 2014. Full text

About Me

I am a pediatrician based at Mohali, a suburb of chandigarh, North India. I have my own virtual office at www.charakclinics.com; I have been a pediatrician since 1994. I hope to make ths blog a regular feature with tonnes of relevant info for parents, especially in India, because i feel that "informed parents are better parents". My interests include research in OPD practice, specifically new vaccines and travel medicine. I am a member of American Academy of Pediatrics, Indian Academy of Pediatrics, and various travel organizations like International Society for Travel Medicine (ISTM), American Society of Tropical Medicine & Hygiene (ASTMH), International Association for Medical Assistance to Travelers (IAMAT), and British & Global Travel Health Association (BGTHA)